multimodal eeg and nirs-based bci with assistive soft robotics for stroke (mbci-sr)

Conditions: Stroke

Summary: one-third of patients who had stroke suffered persistent disabilities, and upper limb (ul) motor impairment is one of the main disabilities. recent clinical studies had been conducted using non-invasive eeg-based bci via motor imagery, for post-stroke rehabilitation, yielded motor improvement of 7.2 on the fugl-meyer motor assessment (fma-ue)score in chronic stroke patients that is significantly better than standard care. however, all the stroke patients underwent the same "one-size-fits-all" treatment option involving all six different activities of daily living (adl)-oriented tasks regardless of their impairment or ability. investigators hypothesize that precision personalized stroke rehabilitation intervention that is tailored to the patient hold more promise than a "one-size-fits-all" stroke rehabilitation strategy.

1. to address the "one-size-fits-all" stroke rehabilitation strategy, rris will develop an ability data-driven personalized stroke rehabilitation based on the stroke patient's ul impairment and motor ability, by first matching 6 ul tasks in rris ability database with the 6 adl tasks of the bci-sr intervention via similarity indices. a personalized subset of adl tasks treatment options is then generated by a data-driven recommendation based on the patient's ability, movement pattern of the treatment option and the normative data from the rris ability database. a multi-modal bci is proposed to perform eeg subject-specific calibration using near-infrared spectroscopy, nirs to ensure motor imagery compliance. 2. stroke subjects with ul impairments (score 11-45 on the fma-ue) will be recruited to undergo the ul tasks assessment at rris. they will then undergo the personalized stroke rehabilitation using the multimodal eeg and nirs-based bci with soft robotic therapy for 1.5 hour over 6 weeks, 3 times a week. the effectiveness of the personalized stroke rehabilitation can then be retrospectively compared to the use of "one-size-fits-all" adl tasks in the previous clinical trial.

Eligibility criteria:
inclusion criteria: * first ever stroke prior to clinical trial * fugl-meyer assessment scale of upper extremity impairment of 11-45 out of a maximum score of 66 * ability to give own consent * ability to pay attention and maintain supported sitting for 1.5 hours continuously * able to comprehend and follow commands * fulfils bci resting brain states on initial screening * unilateral upper limb impairment exclusion criteria: * recurrent stroke * inability to follow command and sit upright for 1.5 hours * hemi-spatial neglect * spasticity assessed by modified ashworth scale more than 2/4 * history of epilepsy * fixed contracture / deformity of finger joints * upper limb pain impeding movements with visual analogy scale \> 4/10 * severe aphasia or cognitive impairment despite visual aids * other conditions ensuing upper limb weakness * poor skin conditions * skull defect that might affect eeg or nirs reading * allergy to electrodes or adhesive gel * significant vision and hearing impairment affecting participation * pregnant women

Keywords: brain-computer interface; upper limb rehabilitation